I Don’t Feel Like Myself: The Most Common Perimenopause Symptoms (and Why They Happen)

Many women describe perimenopause with the same phrase: “I don’t feel like myself.”
You may feel more anxious or irritable than usual, struggle with energy or sleep, or notice changes in your body that do not seem to have a clear explanation. These shifts can feel unsettling, especially when they arrive without warning.

Perimenopause is the transition phase leading up to menopause. It often begins years earlier than expected and can affect how you feel emotionally, mentally, and physically. These changes are real, common, and rooted in how fluctuating hormones influence the nervous system, metabolism, and stress response.

These symptoms are not imagined, exaggerated, or simply part of “getting older.” They reflect real physiological changes taking place in the body.

The Most Common Perimenopause Symptoms

A survey of more than 12,000 women found that many perimenopause symptoms are widely experienced, with the most common self-reported symptoms including fatigue (83%), physical and mental exhaustion (83%), irritability (80%), depressive mood (77%), sleep problems (76%), digestive issues (76%), and anxiety (75%).

Below, we break down the most common ways these symptoms tend to show up and explain why hormonal shifts during perimenopause can affect mood, energy, sleep, and the body as a whole.

Emotional Changes: Anxiety, Low Mood, and Irritability

Mood changes are some of the earliest and most surprising perimenopause symptoms. Many women notice increased anxiety, lower mood, or a shorter emotional fuse, even if they have never struggled with these issues before.

Estrogen plays an important role in supporting brain chemicals that help regulate mood and promote a sense of calm. During perimenopause, estrogen levels do not decline smoothly. Instead, they rise and fall unpredictably. This fluctuation can make the brain more sensitive to stress and emotional triggers.

As a result, situations that once felt manageable may suddenly feel overwhelming. Emotional responses can feel stronger or harder to control, which often leads women to say they no longer recognize themselves.

Fatigue, Brain Fog, and Sleep Issues

Persistent fatigue is another common concern during perimenopause. You may feel tired even after a full night of sleep or struggle to focus during the day.

Progesterone, a hormone that supports calm and restful sleep, often begins to decline during this stage. At the same time, stress hormones may become more active, especially if sleep is disrupted. This combination can make it harder to fall asleep, stay asleep, or wake feeling refreshed.

Over time, poor sleep quality can contribute to brain fog, low motivation, and a sense of mental heaviness that affects daily life.

Weight Gain, PMS Changes, and Cycle Shifts

Changes in weight, appetite, and menstrual cycles are also common during perimenopause. Periods may become shorter, longer, heavier, or more irregular. PMS symptoms may intensify or appear differently than before.

These changes are often linked to shifts in blood sugar regulation and how the body responds to insulin. Estrogen helps influence how the body stores fat and uses energy. When estrogen fluctuates, the body may become more prone to storing weight, especially around the midsection.

It is important to understand that these changes are not a failure of discipline or willpower. They are a reflection of changing physiology and often require a different approach than what worked in earlier years.

Physical Symptoms: Hot Flashes, Palpitations, and Joint Pain

Perimenopause can also bring physical sensations that feel sudden or alarming. Hot flashes, heart palpitations, and joint discomfort are frequently reported.

Estrogen helps regulate body temperature and supports the nervous system. When levels fluctuate, the brain may misinterpret internal signals, leading to sudden waves of heat or changes in heart rhythm. At the same time, shifts in hormones can influence inflammation and connective tissue, contributing to joint stiffness or discomfort.

While these symptoms are common, they should still be evaluated in context to rule out other contributing factors.

The Hormone, Nervous System, and Blood Sugar Connection

Perimenopause does not affect hormones in isolation. Hormones, the nervous system, and blood sugar regulation are closely connected and influence one another throughout the body.

When hormone levels fluctuate, the nervous system can become more reactive. This affects stress tolerance, sleep quality, and emotional regulation. Changes in stress hormones can then influence blood sugar stability, leading to energy crashes, cravings, and increased fatigue.

When these systems fall out of balance at the same time, symptoms often stack rather than appear alone. This is why perimenopause can feel like a collection of unrelated issues, even though they are connected beneath the surface.

What Is “Normal” vs Not Optimal

Some symptoms are common during perimenopause because of natural hormonal shifts. These may include occasional mood changes, mild sleep disruption, changes in cycle timing, or brief periods of lower energy. While uncomfortable, these patterns often fluctuate and do not consistently interfere with daily life.

However, there is an important difference between what is common and what is optimal.

Symptoms such as ongoing anxiety, persistent exhaustion, frequent brain fog, or worsening PMS are often normalized during perimenopause, but they are signs that the body may be struggling to adapt to hormonal changes. These symptoms suggest that additional support could be helpful, even if they are widely experienced.

Red Flags That Should Be Evaluated

Some symptoms fall outside the range of expected hormonal adjustment and should always be assessed by a qualified provider. These include:

• Sudden or severe mood changes
• Heart palpitations accompanied by dizziness or shortness of breath
• Heavy, prolonged, or unpredictable bleeding
• Symptoms that worsen rapidly or interfere with daily functioning

Individualized evaluation helps distinguish between expected hormonal shifts, symptoms that may benefit from support, and patterns that require further medical attention.

Moving Forward With Clarity and Support

Perimenopause can be a confusing and isolating time, especially when symptoms do not fit neatly into one category. Feeling “off” has real physiological explanations, and support should be individualized rather than generalized.

At Flora Naturopathics, perimenopause care focuses on understanding how hormones, stress response, and metabolic health are interacting in your body. Through thoughtful evaluation and personalized support, the goal is to help you make sense of your symptoms and identify steps that may help you feel more stable, energized, and like yourself again.

Perimenopause is a natural transition, but feeling chronically depleted, overwhelmed, or disconnected from yourself does not have to be your baseline. Support during this stage is about helping your body adapt more smoothly, not pushing through symptoms or accepting discomfort as inevitable.

Understanding what is happening in your body is often the first step toward feeling better, and you do not have to navigate this transition on your own.